I saw a patient in clinic the other day and she told me on exploration of her presenting complaint that she probably drank a little more than she should. She offered to do something about it after Christmas but agreed for us to jointly calculate her average weekly alcohol consumption. Her conservative estimate was 92 units – more than six times above the recommended limits.
If you are not a teetotaller, please take a moment and check yours – Please click Here: How many units of alcohol do you drink in a week?
Wikiquote has some humorous quotes on alcoholic beverages. One of them by George Burn says, “It only takes one drink to get me drunk– I can just never remember if it’s the eighth or ninth.” I remember seeing this on a weather-beaten tee shirt in my teens: “I don’t have a drinking problem. I drink, get drunk, fall down, I sleep. NO PROBLEM!”
I wish it was not a problem. The reality is that the World Health Organisation estimates that 3.3 million people die annually from alcohol. There are 60 different types of diseases where alcohol has a significant causal role. It also causes harm to the well-being and health of people around the drinker. Alcohol consumption is estimated to cause from 20% to 50% of cirrhosis of the liver, epilepsy, poisonings, road traffic accidents, violence and several types of cancer.
The Alcohol Journey
When we drink alcohol, small amounts are absorbed in the mouth, gullet and stomach and enter the bloodstream. The bulk of absorption takes place in the small intestines where the alcohol is carried into the liver via the portal vein. In the liver, the alcohol is exposed to two enzymes which break it down, first to a potentially toxic by-product acetaldehyde. If it accumulates, there will be cell and tissue damage and it is rapidly converted by the second enzyme to acetate. Such is the body’s concern to get rid of this toxic by-product of alcohol breakdown that the process is given precedence over the breakdown of carbohydrates, protein and fat.
Alcohol is also broken down and used in production of fatty acids which are converted to fats and deposited in the liver – ‘fatty liver’ – the first stage of liver damage in excessive drinking. Alcohol poisoning can deprive cells, tissues and organs of vital oxygen, especially the brain which could lead to difficulty with regulation of breathing and heart function, ultimately coma and death.
Differences in Alcohol Metabolism
Some people get drunk and disorderly with just one drink while others can keep going. There are several possible reasons:
1. Gender Differences: Men and women have different responses to alcohol. Body size, body water composition, liver size, reduced enzyme activity, slower alcohol breakdown and hormonal fluctuations (peri-menstrual and contraceptive usage) are some suggested reasons.
2. Gastric emptying – how quickly the stomach contents are emptied
3. First Pass Metabolism: Percentage breakdown of alcohol during this first pass through the stomach and liver
4. Environmental factors:
• rate of alcohol drinking
• last meal
• the type of alcoholic
• time of day
• smoking
5. Age
6. Genetic factors: variations in the availability of alcohol-metabolizing enzymes alcohol dehydrogenase and aldehyde dehydrogenase.
How much alcohol is healthy?
In the United Kingdom, the evidence on the health effects of alcohol was reviewed over a three-year period and culminated in new guidelines from 8 January, 2016. The (UK) Chief Medical Officers’ guideline for men and women who drink regularly or frequently i.e. most weeks is that:
• To keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.
• If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over 3 or more days. If you have one or two heavy drinking episodes a week, you increase your risks of death from long term illness and from accidents and injuries.
• The risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis.
• If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.
Drinking and the Law
The police can stop you at any time and ask you to take a breath test (‘breathalyse’ you) if:
• they think you’ve been drinking
• you’ve committed a traffic offence
• you’ve been involved in a road traffic accident
The breath test gives a result straight away. If it shows you’re not over the drink drive limit, you may be allowed to go. In the UK, if you fail the breath test, you’ll be taken to a police station and given a final breath test. If it’s positive, you will be charged.
You may be asked to take a drug test and/or do a physical test (a ‘field impairment test’), e.g. walk in a straight line then turn around and walk back The Morning After the Night Before.
Public enlightenment is helping to reduce drink driving above the limit at night. Many are unaware that they may still be over the legal limit to drive the next morning.
The amount of alcohol ingested, the duration of drinking and the speed at which your body gets rid of it determine what happens the next day. Generally alcohol is removed from the blood at the rate of about one unit an hour with individual variations. Coffee, cold shower or old wives tales won’t make the break down any faster.
If you must drive the morning after, stay within limits the night before and/or stop drinking earlier in the evening. Health Effects of Alcohol.
This video outlines the health effects of alcohol. Of course, there are psychosocial and economic effects on the individual, family, neighbours, work colleagues, the health service and society at large.
Drinking alcohol above sensible limits can have adverse effects on multiple organs:
• Brain & Nervous system
• Throat
• Gullet
• Lungs
• Muscles
• Lungs
• Stomach
• Liver
• Kidneys
• Pancreas
• Sweat Glands
• Sex organs
• Intestines
• Bones
• Fingers
Did you know?
According to the Royal College of Obstetricians and Gynaecologists, “Excessive alcohol lowers testosterone levels and sperm quality and quantity in men. It can also reduce libido, and cause impotence.”
Pregnancy
Best option is not to drink in pregnancy. Drinking above 1-2 unit a day can lead to increased risks of low birth weight, preterm birth, and being small for gestational age.
Last Line:
Enough has been said. What about ‘one for the road?’ Please watch the video clip. It’s less than 3 minutes long: Thank you…
Doctor Hector
KayHector Consulting Ltd
P.S. Christ is the reason for the season, not alcohol, so do everything in moderation.
